The Triangle of Gums Between Teeth and Implants

The little triangle of gums between your front teeth.  Did you ever notice it? Look closely. Between each tooth should be a little triangle of gum called a papillae.

That little tiny triangle of gum is of ultimate importance when having an implant in the front of the mouth.

When you smile big you probably see these triangles. When an implant is ideal it should have a triangle of gum on each side. If it does not, it may look funny. In fact, it may be missing all together leaving a black hole.

There are ways to regenerate these papilla but the best way is to

prevent them from receding. I go through an extensive work up to predict the outcome before surgery ever begins.

The health of your real teeth around the implants is of utmost importance. If the adjacent teeth have even slight bone loss, this could prevent the formation of the papilla or it may not be as big as it is suppose to be.

This triangle of gum should be discussed with you should you elect to have implants for the front teeth. It is especially important if there are multiple dental implants next to each other.

The following pictures show what I call cosmetic failures.  I did NOT treat these patients.  These are dental implants that do not have the papillae:

Image01 DSC_0788
 
These pictures are samples of my work:

Frontal Close up #9

Although this little tiny triangle of gum may be insignificant to you now, it is of paramount importance to me. It makes all the difference!

Let me know if I can help avoid this problem!

 

 

This entry was posted in Dental Implants, Example Dental Implant Cases and tagged . Bookmark the permalink.

69 Responses to The Triangle of Gums Between Teeth and Implants

  1. Sara says:

    Hello Dr Amin
    I am a 22 yr old female. I have lost my 4 upper front teeth after an accident and plan on getting two implants with a bridge.
    My problem is that my gum line is uneven, even though before the accident very little gum would show when I smile I still feel that it made a difference and I feel uncomfortable smiling now.
    My dentist said that due to my gum being thin a gum graft may be unsuccessful. Pink porcelain over crowns was suggested.
    I would be grateful if you can make any recommendations.
    Regards

  2. Hi Sara,
    I know how you feel.
    A gum graft will almost ALWAYS help thin gums but MAY not put the “triangle” back. Do you have any pictures of you in a full, big smile that you can email me?
    That will really help me to give you a better idea. Do you live nearby?
    Dr. Ramsey Amin

  3. Sara says:

    Hello Dr. Amin,
    Thank you for your reply.
    Unfortunately, I do not live nearby. I can definitely e-mail you pictures before and after the accident.
    Can you please let me know on which e-mail I can send them.

  4. In the upper right is an “Email Me” link.
    Go ahead and send it to me there.
    Dr. Amin

  5. Niles Illinois Dentist says:

    Excellent post on the issue. I have also seen very few people care about Triangle of Gums Between Teeth and Implants. Thanks for this nice concern.

  6. Keyro says:

    Hello Dr Amin,
    I just came back from my periodontist in tears because this is going to be an issue with my implants.
    You see, I was born without my lateral incisors and as a result my adult cuspids grew-in in their places. So, 2 years ago, he referred me to an orthodontist. I had my primary incisors pulled and the braces have been moving the cuspids over about 6.5mm to make room to implant the lateral incisors.
    Today he tells me that my teeth are triangular and my gum has flattened next to my central incisors and that my options are to graft the gum, pull my central incisors down (which will in turn pull “a bit” of gum down), or square off my central incisors.
    I’ve finally stopped crying and don’t know what to do. I’m not too keen on them pulling my front teeth down as I fear this may create MORE problems.
    I would be grateful if you can make any recommendations.
    Thank you.

  7. Hi Keyro,
    Do you show your gums when you smile big?

  8. Roga says:

    Dear Doc.,
    I just got done with my Orthodontic treatment. Now my teeth are nice and aligned, and my smile never looked better. The only problem is the small triangles between the teeth and gums. I find that this is the place where the food particles get stuck, etc. Also having these triangles filled would make my smile even better.
    Is is possible? If Yes, what would be the costs involved as a rough ball park estimate?
    Thanks,
    Ro.

    • Hi Ro,

      Are you an adult or a teen? Do you have any bone loss from gum disease even if it is slight?

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow of the American Academy of Implant Dentistry
      Burbank, California
      Voted Best Dentist in Burbank -2006, 2008, 2010, 2011
      http://www.burbankdentalimplants.com

      • Roga says:

        Thanks for the reply Dr. Amin.
        I’m 27. I’m not quite sure but I think I might have a slight bone loss.
        I am curious to know your opinion.
        Thanks.

        • Hi Ro,

          If you have all of your teeth (no implants) then the slight bone loss is more than likely causing this. Often, veneers or bonding are used to fill the spaces if it is truly due to bone loss.
          It would be best to get into the hands of someone in your area to evaluate and diagnose the problem then discuss treatment. Are you local to southern California?

          Dr. Amin

          • Roga says:

            I do have all my teeth. Sorry I live in Texas. I guess I will visit a dentist to see what options do I have.
            Thanks for the advice.

  9. Chatdanai says:

    Dear Dr.Armin

    I have a question regarding your column. I had done my Orthodontic treatment for year and a half. I started to notice my papillae are missing about half a year. But I didn’t really care about them until recently. I am not sure when it started missing actually, maybe even before I’m done with the Orthodontic treatment? Could the treatment be the cause?
    Right now I have few places of papillae missing, they’re not major yet. Noticeable if look closely. I am afraid that it’s going to get worse. Would it get better if I keep my teeth clean and healthy, or at least not getting worse?

    Thanks for your comment in advance,

    • Hi Chatdanai,

      The most likely scenario is you have some degree of pre-existing bone loss between youor teeth. The bone crest between each tooth supports the gum triangle. Now that the teeth have moved from being crooked, the black triangles show because the teeth don’t overlap.

      Are you over 35 years old?

      Ramsey A. Amin, D.D.S., D.A.B.O.I.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      UCLA and Western U. Dental School Faculty

      • Chatdanai says:

        Hi Dr.Amin

        Thank you for your reply.

        No I am about to turn 24 this year.
        I am still thinking that it maybe the side-effect of my Orthodontic treatment. I am also having gum receding on my mandible. I am worrying that it’s going to cause sensitivity and so on.

        Is it normal after Orthodontic treatment to have this problem? Do you have any suggestion on my case?

        Thank you,

  10. Chatdanai says:

    Yes sir.
    Thank you for your time and advice.

  11. Chatshelton says:

    Dr. Amin,
    I have a space between my lower front teeth and I’ve noticed that the pink triangle between them has disappeared. Both teeth look quite long. I thought that I could possibly have a gum graft but it seems that I need papilla to have any chance of success. I’ve just recently set my mind towards investing in orthodontic treatments to correct my teeth. Is it too late for that?

    • Dental implants and teeth can have space that results in a black triangle. This is usually due to bone loss. Since you don’t have an implant, you should consult with your dentist.

      My special training is in implant dentistry not in orthodontics.

      Respectfully,

      Dr. Amin

    • It is never to late for orthodontics. It always helps!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  12. brooke says:

    the triangle of my gums is loose, and may fall off! it is not firm between my teeth but outside, what should i do?

  13. Brin says:

    Dr.Amin,
    I am 13 years old and just got my braces off. I noticed that on my bottom 2 middle teeth the gum part is missing and is leaving a black whole. I asked my orthodontist about it, and he said that it would grow back. I am very concerned and your repy would be greatly appreciated.

    • RamseyAminDDS says:

      Hi Brin,

      At your age the hole should fill in

      ;)

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

      • Samuel says:

        What about if i am a 19 year old who just removed his braces 19 year old this year. Can my one and only small black hole between 2 teeth be filled naturally by my gum tissue?

        • Ramsey Amin DDS says:

          Hi Samuel,

          It is likely that in your situation it will fill in automatically! Good luck!

          Dr. Amin :)

  14. adrian says:

    I just recently had jaw surgery and my mouth is wired shut. Since its wired shut I can only eat liquid foods. I blend all my meals and will be doing so for 4 weeks until i get the wires removed. Since I can’t open my mouth to eat, anytime im eating im sucking in the liquid food. I noticed that the gum in between my 2 front teeth is missing now and i think its due to all the “sucking”. Theres a black hole instead of gum that i never noticed before. I can also tell that this is new because there is a slight burning sensation around that area as if there is damage to the gums. Will this grow back? if not how can i get it back??

    • RamseyAminDDS says:

      Hi Adrian,

      The broken jaw is no fun. It sounds like you had a bad break to have to be wired shut instead of plating the fracture.

      Keep your gums as healthy and clean as you can while the arch bars are on. If your teeth were really healthy before the fracture, the triangle will likely recover.

      Hang in there!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  15. SANDY says:

    DEAR DR. AMIN,
    I JUST HAD IMPLANT ON TOOTH #7. I HAD A STITCH AND SOME ADDED BONE. I WENT TO A GUM AND IMPLANT SPECIALIST. I LIVE IN FLORIDA. i HAD IT DONE THIS MARCH 6TH AND HAVE A FOLLOW UP ON MARCH 14TH. I HAVE A LOT OF PRESSURE ON THE IMPLANT TOOTH AS WELL AS #8 TOOTH ,WHICH WAS PERFECTLY FINE. THEY BOTH FEEL FAKE ,THER E IS A BLUGE INBETWEEN THE IMPANT AND NATURAL TOOTH. WILL THIS BE THERE FOR EVER OR WILL IT HEAL . I AM VERY UPSET. PLEASE LET ME KNOW WHAT YOU THINK. THANK YOU, SANDY

    • Ramsey Amin DDS says:

      Hi Sandy,

      Is the triangle of gum missing now? Is your pain absent now?

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  16. Russell Herman says:

    Dr Amin
    I needed two root canals and two crowns on teeth 29 & 30,my question is my dentist lasered off my interdental papillas completely between teeth #29 & #30 and on the other side of tooth #30,on tooth #30 she did have to do crown lengthening,why would she have lasered off my papillas when she never worked under the gums beneath the papilla area,I now have a large triangle gap between my crowns,that she states will grow back, the papillas are not growing

    • Russell Herman says:

      I feel my dentist lasered my papillas off two get them out of the way so she could work on the post for the teeth

    • Ramsey Amin DDS says:

      Hi Russell,

      The triangle of gum between natural teeth and implants are COMPLETELY different. If the bone is healthy, they will likely grow back. It sounds like you had some deep pockets, so the dentist is helping you to keep these compromised teeth. If you have none loss, they won’t fully grow back, but you are more likely to keep the teeth.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      • Russell Herman says:

        I really don’t understand your answer Dr Ramsey, I had my interdental papilla’s lasered off, now I have a large gap that traps food, the trapped food will increase crown failure. there never was any work done beneath the interdental papilla.

  17. Raj says:

    Recently I underwent through Flap Surgery. Because of the severe Bone loss my 4 Upper front teeth are in very bad condition and the bone loss is reached almost 80- 95 percent. Two teeth are removed at present and they are fixed temporarily, while RC has been done for the other two. My doctor has recommended to go for a bridge of 6 teeth with the support of canine. Can you please suggest in this context.

    • Ramsey Amin DDS says:

      Hi Raj,

      You can rebuild the bone in the area of the four front teeth and not grind down the natural teeth for a bridge. The bridge will be replaced every 5-15 years, even if it is well done.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  18. Lindsey says:

    I am 29 years old and just had my braces removed a few ago. I noticed a black triangle and was wondering if my gum will regenerate to fill in this gap. I have never had a problem with my gums in the past. Thanks!

    • Ramsey Amin DDS says:

      Hi Lindsey,

      Braces are a totally different story than dental implants.

      The triangle of gum is much more likely to come back! Give it a bit of time.

      ;)
      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  19. JP says:

    You mentioned in the article that the papilla can be regenerated. What needs to be done in that case? Should the implant be replaced in order to fix them or is there a better solution? I had a front implant about 3 months ago. Then the papillae went away only on one side of the tooth. There is a black hole as you said. What should be done?

    Thank you.

    • Ramsey Amin DDS says:

      Hi JP,

      If the gum triangle opened after the implant it is NOT likely to come back. :(

      This likely means you are missing bone on the tooth next to the implant or the implant is very deep.

      Without seeing you though it is really impossible for me to give you advice.

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  20. Judith says:

    Hello Doctor,

    I had a tooth removal & implant #19 & 20. The extracted tooth was packed with grafting material & stitched. I am 17 days post op & I am experiencing a nasty taste & discharge. The incision site is now open. The gums are mushy & I pushed on the side last night & a blob of yellow yuck with a stitch came out. I had just seen the oral surgeon 4 days before & he said it looked fine. I told him that I was still experiencing some pain around the extracted tooth site. He did not seem concerned. Am I rejecting the graft material or is it infected?

    Thank you

    • Ramsey Amin DDS says:

      Hi Judith,

      It sounds like you have an infection. Go see your dental implant dentist ASAP.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  21. Natalie says:

    Dear Dr,
    I lost my front tooth, but I still have a root inside. I saw my DDS today, and she wants to do a bridge instead of implant. Her concern is that despite even a successful implant procedure, she has only 50% assurance rate that she will be able to preserve my papilla. She said that its easier to remove the root, do the grafting (placing material inside of my gum to keep it from falling), and do the bridge.
    Do you think she is right, I really had my heart settled on implant?
    Thank you

    • Ramsey Amin DDS says:

      Hi Natalie,

      If you have bone loss on the adjacent teeth, have black triangle spaces are inevitable if an implant is placed in between those teeth. If this is the case, the bridge will look way better. Unless you have a really low lip line and don’t show the area, the bridge would be better. Are you more than 30 years of age?

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  22. Nancy says:

    Hello,
    I have 80% bone loss in my lower front teeth, deep recession, and a very thin front jaw bone. I had tissue grafting about 5 years ago, I have a wire behind my teeth to stabilize them (they are mobile), and I have regular periodontal cleanings. I also have very healthy gums abd I take exceptional care of my teeth. In spite of all this, they continue to worsen. I have large black triangles and am recently developing triangles of black on my top front teeth. I have also developed slight pain on my front left tooth by the gum line(the worst one). I am a 50 yr old female and believe my condition is largely genetic. I do not think I have enough bone or tissue in front for implants. What would you think is my best option? What could be causing the pain? What will happen if all my teeth continue looking bone and tissue? Thanks for your help.

    • Ramsey Amin DDS says:

      Hi Nancy,

      80% bone loss is not sustainable in the long-term. Even though you have lost bone ‘around’ each tooth it doesn’t mean that you have lost the main volume of jaw bone to support an implants. The pain comes from the roots being exposed. They have pores that allow bacteria to enter the roots since they have no enamel.

      I would consider a Prettau full arch implant bridge if you are going to lose all of your teeth.

      Look at the featured case on this page for a sample: http://www.burbankdentalimplants.com/smile-gallery/

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      • Nancy says:

        Thankyou. Is this something that should be considered right away, or should I try to keep my own teeth for as long as possible? Also, in the meantime, is there a cosmetic procedure to hide the growing “black triangles” between my upper front teeth? Will bonding hide the spaces?

        • Ramsey Amin DDS says:

          Hi Nancy,

          Without seeing you it is near impossible to be able to give you a solid answer.

          Sorry,

          Ramsey A. Amin, D.D.S.
          Diplomate of the American Board of Oral Implantology /Implant Dentistry
          Fellow-American Academy of Implant Dentistry

        • Ramsey Amin DDS says:

          Nancy,

          You really should be examined by a dentist in your area as soon as possible. There is no way that I can answer this question without having seen you. X-rays and a thorough dental examination is going to be the most helpful. Look for somebody very skilled and implant dentistry, preferably a diplomate of the American Board of Oral Implantology or dental implant specialist.

          Ramsey A. Amin, D.D.S.

  23. Melissa Mullins says:

    Hi Dr. Amin,
    Im in Iowa, and our new young Dentist in town does not impress with his constant referrals, for my son and I, (it really seems like he just examines) Well in November 2012, I had a Hospital procedure done and they chipped two teeth 12 and 31. No problems with 31 as of yet and it chipped big time. Well 12 became festered, and he suggested having it pulled. I had it pulled Mach 2013, and 12 root was surprisingly long almost half inch if not more (oral surgeon would not let me keep it) but due to how long the root it had caused my sinus cavity (correct?) above to sink in to the empty root. Now I get sinus pain in that area. Would an implant be able to fix that in the future? Also I have noticed since the loss of 12 by bite has change and my teeth are moving more and have gotten more cavities (in a shorter time then when I had braces) I lost a flap of papilla years ago between the 25 and 24, now it has receded so low I have gotten a black hole and tooth 25 is tilting and pushing into 24. I wonder if a “spacer” would help it to remain more up right as the “black hole” heals. When I use flossing stick I pull the floss between the teeth slightly moving it back and it helps with the pain of them moving.
    Thank you.

    • Ramsey Amin DDS says:

      Hi Melissa,

      Sorry to hear about your dental problems. Before having an implant to replace that area I would consider finding out what the source of the pain is. The dental implant will not take away whatever sinus pain you have, so I would definitely not be in pain while having the implant. The source of the pain must be figured out beforehand. You might want to consider seeing an ear nose and throat medical doctor called an ENT.

      The sinus is not usually painful after a tooth extraction but it is normal for bone loss to occur because the sinus expands.

      Once you lose a tooth it sets up a chain reaction of other problems like you described such as cavities and papilla shrinking. It sounds like he really needs to be seen by an excellent dentist and figure out these problems.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  24. Nancy Ruiz says:

    Hello, My name is Nancy Ruiz, I recently finished my invisalign trays and got my gums lasered to raise them and show more teeth, unfortunately in between 2 of my teeth there was a small black triangle left. At first i didn’t know what it was but i felt a little air bubble every time i chewed gum or food, now that I know its there it is very uncomfortable and food always gets stuck in there. I was wondering if there is a way to fix that or if the gum will grow back!?

    • Ramsey Amin DDS says:

      Hello Nancy,

      This would be a better question for your orthodontist. This blog is related to dental implants.

      My guess is used likely have some pre-existing bone loss between those teeth. If you don’t, it should grow back!

      Good luck!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  25. syiriel says:

    i will finish my orthodontics treatment in a short time. but i have black triangles between both my right and left lateral incisors and canine. i would like to know if it is possible to close it my gum graft. i dont like the idea of veneers or anything that will remove my healthy teeth. if i can send u my pic, i will do so. thanks.

    • syiriel says:

      sorry i mean, my black triangle is between my central and lateral incisors, both left and right side.

    • Ramsey Amin DDS says:

      Hi syiriel,

      This would be a great question for your orthodontist. In order to determine whether or not the black triangle will fill in the by itself, small dental x-rays need to be taken to determine how high the crest of your bone is in relation to where your teeth touch in between. We called this the contact point. Photos alone cannot determine this.

  26. andrea says:

    Hello! My name is Andrea and I’m 22 years old.

    2 or 3 months ago my gums got inflamed, but I waited a whole month to see the dentist, because I had to find a new one, and also because I didn’t think it was so serious. By the time I went to the dentist, my papillae have already receded a little, and the inflammation had gotten a little milder. After seeing me, the dentist said I have a form of aggressive periodontitis and prescribed me antibiotics for a week (Metronidazole and Amoxicillin). She then proceeded to do a quick clean of all of my teeth and then made an appointment in a month (which is due today).

    The antibiotics have really helped with keeping the inflammation at bay, but I don’t see any improvement regarding the gum recession. The gums aren’t all that receded, hardly even noticable, but what bothers me are the papillae, the black spaces between the teeth. Do you think there is any chance that my papillae will regrow, or is there some kind of procedure that could help rebuild them?

    • andrea says:

      Also, none of my dentists in the past had ever told me I had any form of gingivitis, and then this happens all of a sudden.

      The dentist also looked shocked and surprised, and said that my teeth look healthy and there isn’t even that much to clean. I’m still not sure what is actually going on inside of my mouth.

      P.S. I have all of my teeth. I have also worn braces for a year and a half when I was 12. Never had any major problems, except for a root canal on my upper left first molar. I’ve had a problem with tooth grinding since I was a child, and it still persists. None of my former dentists ever suggested a dental guard, but this one did. Interesting thing is that the tooth I had a root canal on is the tooth that takes the most pressure when I grind my teeth.

      I hope this additional information can help you.

      • Ramsey Amin DDS says:

        Hello Andrea,

        The papilla between teeth is very difficult to regrow. In your case the aggressive gum disease needs to be treated first. Teeth that have root canals tend to have a little bit more recession also. The treatment of using metronidazole is excellent if you have something as aggressive as what it sounds. Also if your bite is off and you only touch on that one tooth, it will cause inflammation which will result in recession of your gum on that same tooth.

        The ability to rebuild the gum in that area is going to be dependent on how much bone you have underneath it.

        You might require an antibiotic culture and sensitivity to make sure that the antibiotics being used are actually killing off the bacteria that are present in your mouth. Of course excellent home care on your part is going to be a necessity. Ask the dentist to actually show you how to floss your teeth properly. Most people don’t know how.

        Ramsey A. Amin, D.D.S.
        Diplomate of the American Board of Oral Implantology /Implant Dentistry
        Fellow-American Academy of Implant Dentistry

  27. Deborah says:

    Six months ago I had an implant on a tooth next to my upper left front tooth. It is still very much in my smile line.

    My gum grew back fine – but the oral surgeon seemed to have taken off part of my gum on my front tooth–I had fine gums over my front teeth prior to any surgery. Although I am 51 I have had great gums, bones and even hair.

    I think the gum across my front tooth will grow back but my dentist says it wont. He is not a gum man by any means so I hope he is wrong. I asked him if any therapy may speed its growth. It is hairline-but definitely showing that I have a crown on my front tooth. Since the implant area grew back faster than they believed..I am hoping same for my front?

    • Ramsey Amin DDS says:

      Hello Deborah,
      It is not uncommon for gum to shrink after surgical procedures. Anytime you open the gum and place it back there is a risk for it to shrink slightly.

      If the gum is right over the outside of the tooth, your dentist is right, it will not likely grow back on its own.

      It is easy enough to do a tunnel gum graft root coverage procedure in order to slide the gum back over the top. This is a procedure I do routinely in my office to move the gum line back to its original position. You do not always need to have gum taken from your palate in order to slide the gum line back. This will highly depend on how much of your gum is attached and how much needs to be moved.

      http://www.burbankdentalimplants.com/smile-gallery/

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  28. Yolanda says:

    Dr. Amin,

    I am getting implants on teeth 7 and 8. Tooth 8 was only recently extracted from the root but 7 has been out for years therefore, I had to have bone grafting ( only on tooth 7) before I can get my implants placed. Do you think it is possible to get the triangle between these two teeth (7 and 8)? After placing the implants, will my gums simply heal around them thus forming the triangle?

    • Ramsey Amin DDS says:

      hello Yolanda,

      The situation you described of tooth #7 and 8 being replaced with dental implants is the most complex replacement of any in the entire mouth. The reason why is the lack of symmetry. The triangle of gum between tooth #7 tooth #8 can be predicted prior to execution of any surgical procedure. Your dentist must carefully measure the bone and degree of scallop of your gum. Your bone tissue bio type is super important in this situation. None of this can be left to chance.

      You should know prior to even starting treatment whether or not this papilla or triangle of gum will be present after everything is done. If not, there are options to mask it with other restorative technique such as gingival colored ceramics, bonding or other surgical techniques.

      I would suggest a consult with an expert implant dentistry for your situation. Please see this link with examples of all of which I describe.

      http://www.burbankdentalimplants.com/smile-gallery/

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  29. Jesus says:

    I recently got dental crowns on my 8 front teeth on top. How long does it take for the gums to grow to fill in the black triangles in between? It has only been a week since I got them. They are not big spaces but noticable.

  30. Minh B says:

    Hello Dr. Amin,

    I came across your article about this papilla triangle issue while searching for my solution to that exact problem. Unfortunately I have 3 implants on the very front teeth and have the missing triangles that you described as cosmetic failure. My gum is similar to those 2 photos that you have, only far worse…

    Is there anything that could be done to restore my gum? It’s pretty bad…

    I greatly appreciate your insight!

    • Ramsey Amin DDS says:

      Hi Minh,

      Wow… It sounds like you have pretty bad situation if it is worse than these photos. There are not a lot of good options besides trying to mask the black triangles by connecting the 3 teeth together with a bridge utilizing pink, gum colored ceramic.



      If you don’t show a lot of gums when you smile that will be helpful in hiding the pink tissue porcelain. If you have a high smile line, and everything shows, you may want to consider removing everything and starting all over with bone grafting.

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

      • Minh B says:

        Thank you Dr. Amin! While it’s not an answer I was hoping to hear, but you have saved me thousands of dollars paying dentists who claimed to be able to fix it.

        Greatly appreciate!’

        Minh

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